Behavioral and Social Research

Behavioral and lifestyle factors have a profound impact on health throughout the lifespan. For example, older adults can help to prevent disease and disability and improve their quality of life through healthy behaviors such as proper nutrition and exercise, use of preventive health care, and avoiding smoking and alcohol abuse. NIA research on behavioral and social factors in aging encompasses a number of areas, including economic implications of aging at both the personal and societal levels, the effects of behavior and attitude on health, and the demographics of aging.

The Role of Public “Report Cards” in Medical Markets. In recent years, public “report card” programs have been started by both private and public organizations to supply information regarding the quality of medical care provided by hospitals and physicians. By supplying patients and referring physicians with more information when making decisions about where to receive care, report cards can be advantageous. They can also provide hospitals with information that could be used as a guideline to improving care. However, report cards could also create problems. If the performance measures fail to account for the underlying health of the patients being treated, then the measure of performance might reflect more the existing health problems of patients served by a particular hospital than the actual quality of care being rendered. This could lead to flaweddecisionmaking by patients and referring physicians based onpoor data, as well as causing hospitals to become less willing to serve particularly high-risk patients in order to avoid having their reputations penalized. Recently, researchers used Cardiac Surgery Reporting System (CSRS) data from New York State to evaluate the impact of report cards on the distribution of where patients go for bypass surgery, and whether good or bad reports lead to improvements in the quality of care, measured by mortality. In their study, being reported as a poor performer (“high mortality”) was associated with a 10 percent reduction in bypass surgery patients per month in the 12 months following the report. The shift appeared to be primarily due to patients and referring doctors choosing to have procedures performed at low-mortality hospitals. However, the researchers found that hospitals flagged as poor performers improve patient mortality by 1.2 percentage points within the 12 month period following the report. Since this study took into account the severity of patient condition, the latter change does not appear to be simply due to sicker patients moving to low mortality hospitals. Indeed, the findings show that low-performing hospitals lose relatively healthy patients to competing facilities. While additional research is needed to identify exactly what mechanisms underlie the reported changes, the findings do provide evidence that report cards could have a beneficial impact on the quality of healthcare.